Sevelamer Dosage and Administration

Administration

Oral Administration

Dosage

Available as sevelamer carbonate and sevelamer hydrochloride; dosage expressed in terms of the salts.123 Sevelamer carbonate dosage expected to be similar to that of sevelamer hydrochloride because of rapid disintegration of sevelamer carbonate tablets in gastric hydrochloric acid.23

For the treatment of hyperphosphatemia in patients currently receiving sevelamer hydrochloride therapy, the recommended initial dosage of sevelamer carbonate is equivalent to the patient's current sevelamer hydrochloride dosage on a gram per gram basis.23

Adjust dosage of sevelamer carbonate for all patients according to the patient’s serum phosphorus concentrations with the goal of controlling serum phosphorus concentrations within the target range of 3.5–5.5 mg/dL.23 Increase or decrease dosage in increments of 1 tablet (800 mg) per meal at 2-week intervals as needed.23

Average dosage of sevelamer carbonate in one study was 6 g daily; maximum dosage studied was 14 g daily.23

Adjust dosage of sevelamer hydrochloride for all patients according to serum phosphorus concentrations with the goal of reducing concentrations to ≤5.5 mg/dL.1 Increase or decrease dosage in increments of 1 tablet (400 or 800 mg) per meal at 2-week intervals as needed.1722

Cautions for Sevelamer

Contraindications

Warnings/Precautions

General Precautions

GI Disease or Surgery

Use with caution in patients with swallowing or severe GI motility disorders (including severe constipation), dysphagia, or major GI tract surgery.123 Provide appropriate treatment to patients who develop constipation or experience worsening of existing constipation to avoid the development of severe complications (e.g., fecal impaction, ileus, intestinal obstruction, intestinal perforation).123

Monitor patients on peritoneal dialysis for proper use of aseptic technique and for signs and symptoms of peritonitis.123

Effects on Vitamins

Sevelamer hydrochloride has decreased plasma concentrations of vitamins D, E, and K and folic acid in animals when given at doses 6–10 times the recommended human dosage.1 No evidence of decreased vitamin concentrations in some short-term studies of patients receiving sevelamer hydrochloride;12523 however, a decrease in serum 25-hydroxy vitamin D3 concentrations from 39 to 34 mcg/mL (normal range: 10–55 mcg/mL) was reported in one 1-year study.1 Most patients (75%) in clinical studies of sevelamer hydrochloride have received vitamin supplements.123 Monitor for reduced serum concentrations of vitamin D, E, K (clotting factors) and folic acid.1

Common Adverse Effects

Interactions for Sevelamer

Effects on GI Absorption of Drugs

Possible decreased bioavailability of orally administered drugs given concomitantly; when reduced bioavailability would have a clinically important effect on the drug's safety or efficacy, administer the drug ≥1 hour before or 3 hours after sevelamer administration or consider monitoring blood concentrations.123

Specific Drugs

No drug interaction studies have been performed with sevelamer carbonate.23 Drug interactions studies have been performed with sevelamer hydrochloride in humans.23